Sulhattin ARSLAN, Serdar BERK, Sefa Levent ÖZŞAHİN, Gülizar Canan ŞANLI, İbrahim AKKURT, Ömer Tamer DOĞAN

Bir üniversite hastanesinde solunumsal maluliyet değerlendirme pratiği: 136 hastanın analizi

Giriş: Bu çalışmanın amacı, solunumsal maluliyetin değerlendirilmesi talebiyle kliniğimize başvuran hastaların sonuçları-nı irdelemektir.Materyal ve Metod: Çalışmada, Ocak 2010-Haziran 2011 tarihleri arasında göğüs hastalıkları polikliniğimize solunumsalmaluliyetin değerlendirilmesi için başvuran ardışık 136 hastanın raporları retrospektif olarak incelendi.Bulgular: On sekiz aylık dönemde göğüs hastalıkları polikliniğimize başvuran 10.457 hastadan 136 (%1.3)sının solunumsalmaluliyetin değerlendirilmesi için başvurduğu belirlendi. Yaş ortalaması 51 ± 12 yıl olan hastaların 118 (%87)i erkekti. Has-taların %19.8inin çiftçilik, %10.7sinin maden/döküm işçiliği yaptığı, en sık nefes darlığı (%91.2) ve öksürük (%76.5) yakın-malarının olduğu, radyolojik olarak en sık (%38.2) retiküler/nodüler opasitelerin saptandığı belirlendi. Yapılan tetkikler sonu-cu hastaların 64 (%47)üne kronik obstrüktif akciğer hastalığı, 19 (%14)una interstisyel akciğer hastalığı/pnömokonyoz tanı-sı konulurken, 19 hastada herhangi bir akciğer hastalığı saptanmadığı belirlendi. Hastalardan 98 (%72.1)inin başka bölüm-lere de maluliyet değerlendirmesi için başvurduğu belirlendi. Maluliyet oranı hesaplanan 44 (%32.4) hastanın 8 (%18.2)inin%60 ve üzeri, 13ünün %0 iş göremez raporu aldığı belirlendi. Maluliyet oranlarıyla yaş, solunumsal semptom süreleri, PaCO2değerleri arasında pozitif korelasyon (sırasıyla r= 0.395, p= 0.008; r= 0.391, p= 0.009; r= 0.790, p< 0.001), FVC, FEV1, PaO2, de-ğerleri arasında negatif korelasyon olduğu belirlendi (sırasıyla r= -0.681, p< 0.001; r= -0.766, p< 0.001; r= -0.661, p= 0.003). Li-neer regresyon analizinde yüksek PaCO2 değerlerinin yüksek maluliyet oranı hesaplanmasında belirleyici olduğu (r= 0.902,p= 0.014), ayrıca sigara içenlerde içmeyenlerden daha yüksek maluliyet oranı hesaplandığı saptandı (p< 0.001).Sonuç: Solunumsal maluliyet değerlendirmesindeki tıbbi, yasal ve sosyal belirsizliklerin giderileceği, hekime bilimsel yolgöstericiliği olan yeni rehberlere gereksinim olduğu düşüncesindeyiz.

The practice of respiratory disability assessment in a university hospital: the analysis of 136 patients

Introduction: This study, to examine the outcomes of the respiratory disability assessment in our clinic.Materials and Methods: The reports of 136 patients who attended the chest diseases clinic between January 2010 and Ju-ne 2011 for the assessment of the respiratory disability were examined retrospectively.Results: Of 10.457 patients who presented in 18 months, 136 (1.3%) requested the assessment of the respiratory disa-bility. The patients average age was 51 ± 12 years and 118 (87%) were male. Farmers constituted 19.8% of the pati-ents and mine and foundry workers 10.7% of the patients. The most frequent symptoms were dyspnea (91.2%) and co-ugh (76.5%). The most frequent radiological pattern was reticular and nodular opacities (38.2%). The workup led to adiagnosis of chronic obstructive pulmonary disease in 64 patients (47%) and of interstitial pulmonary disease/pneumo-coniosis in 19 (14%) patients. No respiratory disease was found in 19 patients. Among 44 (32.4%) patients for whomdisability rate was calculated, 8 (18.2%) had an incapacity rate of 60% or higher and 13 had 0%. The disability ratesshowed positive correlations with age, the duration of the respiratory symptoms and PaCO2 level (respectively r=0.395, p= 0.008; r= 0.391, p= 0.009; r= 0.790, p< 0.001), and negative correlations with FVC, FEV1 and PaO2 levels (res-pectively r= -0.681, p< 0.001; r= -0.766, p< 0.001; r= -0.661, p= 0.003). Linear regression analysis showed that high Pa-CO2 value is a determinant for a high disability rate (r= 0.902, p= 0.014). Furthermore, smokers had higher disabilityrates than non-smokers (p< 0.001).Conclusion: We believe that new evidence-based guidelines that will resolve the medicolegal and social obscurities are needed.

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